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General NPI Number Information
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NPI Number | 1114711900
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Entity Type | Organization
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Legal Business Name | GREATER BOSTON FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 35 HIGHLAND CIR STE 101
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City | NEEDHAM
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State | MA
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Zip | 02494-3033
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Country | US
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Telephone | 781-973-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HIGHLAND CIR STE 101
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City | NEEDHAM
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State | MA
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Zip | 02494-3033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUISA MAZAEVA
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Credential | FNP
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Telephone | 781-973-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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